Maternal Mortality in Nigeria: Tackling Hypertensive Disorders in Pregnancy, Perspectives, and the Noble Preventive Approaches

Introduction

Maternal mortality, defined as the death of a woman during pregnancy, childbirth, or within 42 days post-delivery, is a pressing global concern. Nigeria, the most populous African nation, faces a staggering estimate of 512 maternal deaths per 100,000 live births, as reported by the World Health Organization (WHO)¹. Approximately 200 million individuals reside in Nigeria, which is recognized as the most populous country in Africa. Nigeria is also the nation where almost 20% of global maternal deaths take place. In the period from 2005 to 2015, it is approximated that the country experienced over 600,000 maternal deaths and a minimum of 900,000 instances of maternal near-miss.

The WHO provides essential insights into the global maternal mortality landscape, highlighting the significant role of hypertensive disorders in maternal deaths worldwide. In conjunction with this, the Centers for Disease Control and Prevention (CDC) contribute nuanced perspectives on risk factors and preventive measures on a global scale, providing a comprehensive overview of effective interventions.

This essay delves into the critical issue of hypertensive disorders in pregnancy, offering insights into the current scenario and proposing innovative preventive strategies to counteract this alarming trend, particularly in the Nigerian context.

Maternal Mortality in Nigeria

Despite concerted global efforts to enhance maternal health, Nigeria continues to grapple with a persistently high maternal mortality rate. Key contributors include bleeding, infections, and notably, hypertensive disorders in pregnancy. These disorders, comprising gestational hypertension, preeclampsia, and eclampsia, significantly contribute to maternal deaths, highlighting the need for targeted interventions and enhanced maternal healthcare infrastructure.

Nigeria faces distinctive challenges in combating maternal mortality, shaped by cultural, and socioeconomic factors, and healthcare access disparities. Evidence unveils a complex interplay of these elements, underscoring the urgency of addressing hypertensive disorders as significant contributors to maternal deaths². Bridging healthcare access gaps and addressing cultural nuances are pivotal for formulating effective maternal health strategies.

Hypertensive Disorders in Pregnancy

A comprehensive examination of hypertensive disorders, including gestational hypertension, preeclampsia, and eclampsia, reveals severe threats to maternal health. Understanding the distinct characteristics of each disorder is crucial for developing targeted preventive strategies.

Risk factors for hypertensive disorders include:

• First-time pregnancies: Women pregnant for the first time are at an increased risk.
• Age:Women under 20 or over 35 years old face higher risks.
• Pre-existing conditions: Chronic hypertension, diabetes, and kidney disease elevate the risk.
• Multiple pregnancies: Carrying twins or higher multiples increases the likelihood.

Signs and symptoms of hypertensive disorders include:

• High blood pressure: Persistent elevated blood pressure is a key indicator.
• Proteinuria: Presence of excess protein in the urine signals kidney dysfunction.
• Swelling: Edema, particularly in the hands and face, may occur.
• Headaches: Severe headaches warrant attention.
• Visual disturbances: Blurred vision or light sensitivity may be indicative.

Early detection and intervention are vital, emphasizing the importance of regular prenatal care to monitor and manage these conditions.

The way forward

In the context of maternal mortality in Nigeria and specifically addressing hypertensive disorders in pregnancy, cutting-edge preventive approaches involve innovative strategies that go beyond traditional methods. Here are some elaborations on these cutting-edge preventive approaches:

Community Engagement and Education: Implementing innovative community engagement and education programs is vital for raising awareness about hypertensive disorders and promoting early detection. Interactive workshops and community-based health campaigns can empower women and families with knowledge about risk factors, symptoms, and the importance of regular prenatal care.

Early Identification of Risk Factors: Emphasizing the early identification of risk factors is a key preventive strategy, especially with the strict implementation of the WHO-focused antenatal care model. Healthcare providers can use advanced screening tools and predictive analytics to identify high-risk pregnancies. Early intervention can then be initiated, including personalized care plans, lifestyle modifications, and, if necessary, the administration of preventive medications such as aspirin.

Preventive Medications and Management Strategies: Exploring and implementing preventive medications, such as aspirin, in high-risk pregnancies can be part of a cutting-edge approach. Additionally, innovative management strategies for conditions like hypocalcemia can contribute to reducing the severity of hypertensive disorders, thereby preventing maternal mortality. Thankful, these drugs are made available at the Nigerian primary level 1-3 primary healthcare facilities as first contact care to these vulnerable populations. Early antenatal booking goes a long way in preventing hypertension-related and other pregnancy-related complications.

Collaborative Partnerships: Forming collaborations among government entities, non-governmental organizations (NGOs), private sectors, and international agencies is crucial. These partnerships can pool resources, share expertise, and implement comprehensive maternal health programs. Collaborative efforts enhance the efficiency of healthcare delivery, ensuring that preventive measures are accessible to a larger population.

This holistic approach aims not only to reduce maternal mortality rates but also to ensure the well-being of mothers and infants throughout the pregnancy and post-delivery periods.

Conclusion

In conclusion, maternal mortality in Nigeria demands urgent attention, with hypertensive disorders playing a significant role. Global perspectives offer valuable insights, while local data underscores unique challenges. Prospects for improvement rest in a combination of existing initiatives and innovative preventive strategies. Addressing hypertensive disorders through research, education, and technological interventions can pave the way for substantial reductions in maternal mortality rates, ensuring the well-being of mothers and infants. This holistic approach is essential for achieving sustainable progress in maternal healthcare in Nigeria. Early detection, risk factor awareness, and community engagement are pivotal in achieving this goal.

An Article by: Dr. Suleiman Muhammad Farusi (suleimanmoh6@gmail.com)

Department of Reproductive Health, University of Maiduguri Teaching Hospital